Overview Bunions are bony bumps that form on the side of the big toe joint or baby toe joint (these are commonly called ?bunionettes? or ?tailor?s bunions?). Bunions most commonly result from one or more of the following factors: genetics, faulty foot mechanics like over-pronation, and/or long periods of time spent in improperly fitting footwear. Bunions can start with audible clicking (called ?crepitus?) and/or stiffness in the affected joint which indicates that the joint surfaces are rubbing together improperly. This may progress to include inflammation, degeneration of the surfaces of the joint, deformity (including bone growth at the joint line and displacement of the toe) and ultimately, loss of range of motion in the joint.

Causes
Many problems that occur in the feet are the result of abnormal pressure or rubbing. One way of understanding what happens in the foot due to abnormal pressure is to view the foot simply. Our simple model of a foot is made up of hard bone covered by soft tissue that we then put a shoe on top of. Most of the symptoms that develop over time are because the skin and soft tissue are caught between the hard bone on the inside and the hard shoe on the outside. Any prominence, or bump, in the bone will make the situation even worse over the bump. Skin responds to constant rubbing and pressure by forming a callus. The soft tissues underneath the skin respond to the constant pressure and rubbing by growing thicker. Both the thick callus and the thick soft tissues under the callus are irritated and painful. The answer to decreasing the pain is to remove the pressure. The pressure can be reduced from the outside by changing the pressure from the shoes. The pressure can be reduced from the inside by surgically removing any bony prominence.

Symptoms
Red, thickened skin along the inside edge of the big toe. A bony bump at this site. Pain over the joint, which pressure from shoes makes worse. Big toe turned toward the other toes and may cross over the second toe.

Diagnosis
Your doctor will be able to diagnose a bunion by asking about your symptoms and examining your feet. You may also have blood tests to rule out any other medical conditions, such as rheumatoid arthritis or gout, although this is rare. Your doctor may refer you to a podiatrist or chiropodist (healthcare professionals who specialise in conditions that affect the feet).

Non Surgical Treatment
Sometimes observation of the bunion is all that's needed. A periodic evaluation and x-ray examination can determine if your bunion deformity is advancing, thereby reducing your chance of irreversible damage to the joint. In many other cases however some type of treatment is needed. Early treatments are aimed at limiting the progression of the deformity and easing the pain of the bunion or an associated joint. Conservative treatments such as orthotics can achieve this but they won't reverse the deformity itself. These options include changes in shoe wear. Foot Mechanics Podiatrists are experts in shoe recommendation. Padding. Pads placed over the area of the bunion can help minimise pain, but will not stop the progression of the bunion. Activity modifications. Avoid activity that causes bunion pain, this could include standing for long periods of time. Medications. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen may help to relieve pain. Icing. Applying an ice pack several times a day helps reduce inflammation and pain. Orthotic devices. Orthotics are the mainstay of non-surgical treatment for bunions.

Surgical Treatment
There is no "standard" bunion, but rather a complex range of joint, bone, muscle, tendon and ligament abnormalities that can cause variation in each bunion's make-up. As a result, there are a broad variety of surgical techniques for dealing with bunions. Most surgical procedures start with a simple bunionectomy, which involves excision of swollen tissues and removal of the enlarged boney structure. While this may remove the troublesome tissues, however, it may not correct other issues associated with the bunion. The surgeon may also need to tighten or loosen the muscles, tendons and ligaments around the MTP joint. Realign the bone by cutting it and shifting its position (a technique called osteotomy), realigning muscles, tendons and ligaments accordingly. Use screws, wires or plates to hold the joint surfaces together until they heal. Reconstruct a badly damaged joint or replace it with an artificial implant.

Prevention
To help prevent bunions be sure your shoes don't cramp or irritate your toes. Choose shoes with a wide toe box - there should be space between the tip of your longest toe and the end of the shoe. Your shoes should conform to the shape of your feet without squeezing or pressing any part of your foot. Avoid pointy-toed shoes.